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Richards S, Bailey KE, Scarborough R, Gilkerson JR, Browning GF, Hur B, Ierardo J, Awad M, Chay R, Hardefeldt LY. Cross-sectional evaluation of a large-scale antimicrobial stewardship trial in Australian companion animal practices. Vet Rec 2024; 194:e3268. [PMID: 37518680 DOI: 10.1002/vetr.3268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/22/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Antimicrobial stewardship programmes (ASPs) are critically important for improving the appropriate use of antimicrobial agents in veterinary practice. METHODS One of three ASPs was implemented in 135 Australian general veterinary practices in 2018-2020. The ASP interventions and the perceived impact they had on antimicrobial prescribing were assessed by the veterinarians working in these veterinary practices. An online survey was distributed to all 520 veterinarians working in the trial practices and 267 responses were analysed. RESULTS Most veterinarians (174/267, 65%) thought they had an ASP at their clinic and most respondents who said that they were aware that they had an ASP at their clinic indicated that they had changed the way they prescribed antimicrobials because of the trial (125/170, 74%). Antimicrobial prescribing guidelines, the traffic light system for indicating antimicrobial importance, delayed prescribing and antimicrobial stewardship champions were reported to have had the biggest impact. LIMITATIONS All practices in the trial belong to a single corporate group, which may impact the external validity of these results when applied to general small animal practice. CONCLUSION Antimicrobial stewardship has a positive impact on antimicrobial prescribing in veterinary medicine and future interventions should focus on the implementation of the effective interventions identified in this study.
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Affiliation(s)
- Suzanna Richards
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Science, University of Melbourne, Parkville, Victoria, Australia
- Peter Doherty Institute, National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
| | - Kirsten E Bailey
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Science, University of Melbourne, Parkville, Victoria, Australia
- Peter Doherty Institute, National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
| | - Ri Scarborough
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Science, University of Melbourne, Parkville, Victoria, Australia
- Peter Doherty Institute, National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
| | - James R Gilkerson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Science, University of Melbourne, Parkville, Victoria, Australia
- Peter Doherty Institute, National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
| | - Glenn F Browning
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Science, University of Melbourne, Parkville, Victoria, Australia
- Peter Doherty Institute, National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
| | - Brian Hur
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Science, University of Melbourne, Parkville, Victoria, Australia
- Peter Doherty Institute, National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Jessica Ierardo
- Greencross Pet Wellness Company, North Ryde, New South Wales, Australia
| | - Magdoline Awad
- Greencross Pet Wellness Company, North Ryde, New South Wales, Australia
| | - Rachel Chay
- Greencross Pet Wellness Company, North Ryde, New South Wales, Australia
| | - Laura Y Hardefeldt
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Science, University of Melbourne, Parkville, Victoria, Australia
- Peter Doherty Institute, National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
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Hur B, Verspoor KM, Baldwin T, Hardefeldt LY, Pfeiffer C, Mansfield C, Scarborough R, Gilkerson JR. Using natural language processing and patient journey clustering for temporal phenotyping of antimicrobial therapies for cat bite abscesses. Prev Vet Med 2024; 223:106112. [PMID: 38176151 DOI: 10.1016/j.prevetmed.2023.106112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/09/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Temporal phenotyping of patient journeys, which capture the common sequence patterns of interventions in the treatment of a specific condition, is useful to support understanding of antimicrobial usage in veterinary patients. Identifying and describing these phenotypes can inform antimicrobial stewardship programs designed to fight antimicrobial resistance, a major health crisis affecting both humans and animals, in which veterinarians have an important role to play. OBJECTIVE This research proposes a framework for extracting temporal phenotypes of patient journeys from clinical practice data through the application of natural language processing (NLP) and unsupervised machine learning (ML) techniques, using cat bite abscesses as a model condition. By constructing temporal phenotypes from key events, the relationship between antimicrobial administration and surgical interventions can be described, and similar treatment patterns can be grouped together to describe outcomes associated with specific antimicrobial selection. METHODS Cases identified as having a cat bite abscess as a diagnosis were extracted from VetCompass Australia, a database of veterinary clinical records. A classifier was trained and used to label the most clinically relevant event features in each record as chosen by a group of veterinarians. The labeled records were processed into coded character strings, where each letter represents a summary of specific types of treatments performed at a given visit. The sequences of letters representing the cases were clustered based on weighted Levenshtein edit distances with KMeans+ + to identify the main variations of the patient treatment journeys, including the antimicrobials used and their duration of administration. RESULTS A total of 13,744 records that met the selection criteria was extracted and grouped into 8436 cases. There were 9 clinically distinct event sequence patterns (temporal phenotypes) of patient journeys identified, representing the main sequences in which surgery and antimicrobial interventions are performed. Patients receiving amoxicillin and surgery had the shortest duration of antimicrobial administration (median of 3.4 days) and patients receiving cefovecin with no surgical intervention had the longest antimicrobial treatment duration (median of 27 days). CONCLUSION Our study demonstrates methods to extract and provide an overview of temporal phenotypes of patient journeys, which can be applied to text-based clinical records for multiple species or clinical conditions. We demonstrate the effectiveness of this approach to derive real-world evidence of treatment impacts using cat bite abscesses as a model condition to describe patterns of antimicrobial therapy prescriptions and their outcomes.
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Affiliation(s)
- Brian Hur
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia; School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia; Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, WA, USA.
| | - Karin M Verspoor
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia; School of Computing Technologies, RMIT University, Melbourne, Victoria, Australia
| | - Timothy Baldwin
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia; Department of Natural Language Processing, Mohamed bin Zayed University of Artificial Intelligence, Abu Dhabi, United Arab Emirates
| | - Laura Y Hardefeldt
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
| | - Caitlin Pfeiffer
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
| | - Caroline Mansfield
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
| | - Riati Scarborough
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
| | - James R Gilkerson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
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Weese JS, Battersby I, Morrison J, Spofford N, Soltero-Rivera M. Antimicrobial use practices in canine and feline dental procedures performed in primary care veterinary practices in the United States. PLoS One 2023; 18:e0295070. [PMID: 38064486 PMCID: PMC10707603 DOI: 10.1371/journal.pone.0295070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
This study examined the utilization of antimicrobials in canines and felines receiving dental treatments in veterinary clinics in the United States, retrospectively. A total of 818,150 animals (713,901 procedures in dogs and 104,249 procedures in cats) underwent dental procedures under general anesthesia in 2020. These included dental prophylaxis and extractions. Patient demographic data, antimicrobial treatment, treatment duration, dose, periodontal disease score, whether tooth extractions were performed and how many extractions were performed was recorded. Our results showed that local or systemic antimicrobials were used in 116,723/713,901 (16.4%) procedures in dogs and 14,264/104,249 (14%) procedures in cats. Age, weight, extraction of one or more teeth and diagnosis of periodontal disease (any stage) were associated with increased likelihood of antimicrobial administration using univariable analysis (all P<0.001) and in the multivariable model. Clindamycin, amoxicillin-clavulanate and amoxicillin were the most common oral antimicrobials used in dogs and cats. Drugs classified as highest priority clinically important antibiotics (HPCIA) were administered to 30,960/116,723 (26.5%) of dogs and 7,469/14,264 (52%) of treated cats. The results obtained can inform interventions to optimize patient care and promote prudent use of antimicrobials during dental procedures in canine and feline patients.
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Affiliation(s)
- J. Scott Weese
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Ian Battersby
- Mars Veterinary Health, Vancouver, WA, United States of America
| | - JoAnn Morrison
- Banfield Pet Hospital, Vancouver, WA, United States of America
| | | | - Maria Soltero-Rivera
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, CA, United States of America
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Redding LE, Reilly K, Radtke B, Bartholomew S, Cole SD. The potential role of veterinary technicians in promoting antimicrobial stewardship. BMC Vet Res 2023; 19:142. [PMID: 37660006 PMCID: PMC10474764 DOI: 10.1186/s12917-023-03637-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/28/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND A core principle of antimicrobial stewardship (AMS) in veterinary settings is the need for engagement of all stakeholders; however, no studies have addressed the role of veterinary technicians in AMS specifically. The objective of this study was to qualitatively assess knowledge, opinions, and practices related to AMS among technicians. Semi-structured interviews were conducted with 33 veterinary technicians with varied backgrounds, experience and roles. Interviews centered on participants work experience and interactions with their employer, perceptions of antimicrobial resistance and overuse in veterinary medicine, observed application of AMS principles, opinions on potential opportunities for technicians to contribute to AMS and concomitant potential barriers to these opportunities. Transcripts of interviews were coded thematically by two authors, then organized into a hierarchical framework, and the characterization of codes was compared across different categories of respondents. RESULTS Most veterinary technicians were knowledgeable about antimicrobial drugs but could not provide a complete definition of antimicrobial resistance or AMS. Most veterinary technicians could identify examples of antimicrobial misuse. Participants identified areas of client education and discussion with veterinarians as potential areas to contribute to AMS. Barriers identified included hierarchical structures of veterinary practices and time-constraints. Most participants expressed a personal interest in participating in AMS. CONCLUSIONS There is a possible appetite among some veterinary technicians to participate in AMS and they already play applicable roles in practices. Barriers such as educational needs, hierarchical structures of veterinary practices and time constraints will need to be addressed if technicians are included in AMS efforts.
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Affiliation(s)
- Laurel E Redding
- Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Philadelphia, PA, USA
| | - Katherine Reilly
- Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Philadelphia, PA, USA
| | - Bridget Radtke
- Department of Pathobiology, School of Veterinary Medicine, Philadelphia, PA, USA
| | - Stacy Bartholomew
- Department of Veterinary Technology, Manor College, Jenkintown, PA, USA
| | - Stephen D Cole
- Department of Pathobiology, School of Veterinary Medicine, Philadelphia, PA, USA.
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Scarborough RO, Sri AE, Browning GF, Hardefeldt LY, Bailey KE. ‘Brave Enough’: A Qualitative Study of Veterinary Decisions to Withhold or Delay Antimicrobial Treatment in Pets. Antibiotics (Basel) 2023; 12:antibiotics12030540. [PMID: 36978407 PMCID: PMC10044613 DOI: 10.3390/antibiotics12030540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Veterinarians sometimes prescribe antimicrobials even when they know or suspect that they are unnecessary. The drivers of this behaviour must be understood to design effective antimicrobial stewardship interventions. Semi-structured interviews were conducted with 22 veterinarians who treated companion animals in Australia. The Theory of Planned Behaviour was used to organise interview themes, focusing on a decision to withhold antimicrobial therapy in the absence of a clear indication. Many background factors influenced antimicrobial-withholding decisions, including the veterinarian’s communication skills, general attitudes towards antimicrobial resistance (AMR), habits and energy levels. Client awareness of AMR and the veterinarian–client relationship were also important. Beliefs about the consequences of withholding antimicrobials (behavioural beliefs) were dominated by fears of the animal’s condition deteriorating and of failing to meet client expectations. These fears, weighed against the seemingly distant consequences of AMR, were major barriers to withholding antimicrobials. Normative beliefs were primarily focused on the expected approval (or disapproval) of the client and of other veterinarians. Control beliefs about the difficulty of withholding antimicrobials centred around client factors, most importantly, their capacity to adequately monitor their animal, to pay for further investigations, or to undertake non-antimicrobial management, such as wound care, at home. The use of antimicrobials by companion animal veterinarians in the absence of a clear indication is often powerfully driven by behavioural beliefs, chiefly, fears of clinical deterioration and of failing to meet client expectations.
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Affiliation(s)
- Ri O. Scarborough
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, VIC 3010, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Parkville, VIC 3052, Australia
- Correspondence:
| | - Anna E. Sri
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, VIC 3010, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Parkville, VIC 3052, Australia
| | - Glenn F. Browning
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, VIC 3010, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Parkville, VIC 3052, Australia
| | - Laura Y. Hardefeldt
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, VIC 3010, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Parkville, VIC 3052, Australia
| | - Kirsten E. Bailey
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, VIC 3010, Australia
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Parkville, VIC 3052, Australia
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Kardomatea N, Hopman NEM, van Geijlswijk IM, Portengen L, Wagenaar JA, Heederik DJJ, Broens EM. Quantifying topical antimicrobial use before and during participation in an antimicrobial stewardship programme in Dutch companion animal clinics. PLoS One 2023; 18:e0283956. [PMID: 37053211 PMCID: PMC10101466 DOI: 10.1371/journal.pone.0283956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
The emergence of bacterial strains resistant to topical antimicrobials in both human and veterinary medicine has raised concerns over retaining the efficacy of these preparations. Yet, little information is available regarding the use of topical antimicrobials in either sector for planning targeted interventions. This study aims to quantify the use of topical antimicrobials in 44 Dutch companion animal clinics before and during their participation in an antimicrobial stewardship programme (ASP), to explore the effect of the intervention on topical antimicrobial use (AMU). Hence, prescription and clinic animal population data, collected from July 2012 until June 2018 were used. Specifically, the period from July 2012 until June 2015 was defined as pre-intervention period, whereas clinics started to participate in the ASP from March 2016 onwards. As quantification metric, the Defined Daily Dose for Animals (DDDA) was used and a mixed effect times series model with auto-regression was applied to monthly topical AMU data. The intervention effect was modelled using a step function with a change in (linear) time trend and clinic characteristics, as potential determinants of topical AMU, were assessed using a multivariable regression model. A seasonal pattern was identified, in the pre-intervention period, where topical AMU was highest in July-August and lowest in February-March. In addition, total topical AMU appeared to significantly decrease over time in the pre-intervention period and the proportion of dogs in the clinic was positively associated with topical AMU. The intervention effect was significant only for second line and for skin product AMU. This study demonstrates that during participation in an ASP, second line and skin product AMU decreased in Dutch companion animal clinics. Additionally, this study demonstrates the existence of a seasonal effect and a decrease in topical AMU over time already before introduction of a targeted intervention.
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Affiliation(s)
- Nafsika Kardomatea
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nonke E M Hopman
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Ingeborg M van Geijlswijk
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Lützen Portengen
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jaap A Wagenaar
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Dick J J Heederik
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Els M Broens
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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7
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Bailey KE. Antimicrobial stewardship: the role of vets in combating antimicrobial resistance. Vet Rec 2022; 190:498-500. [PMID: 35714028 DOI: 10.1002/vetr.1926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Kirsten E Bailey
- National Centre for Antimicrobial Stewardship, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
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